Evidence map›Paper›PMID 39708166›Full record

ArticleArchives of orthopaedic and trauma surgery2024

Does the treatment modality affect nosocomial pneumonia and other in-hospital outcomes in patients with combined injuries to the ribs and clavicle? A propensity score weighted analysis of a retrospective cohort.

Tim Kobes, Mark C P M van Baal, Marilyn Heng

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Article in Archives of orthopaedic and trauma surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

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5 · Who and what money

Authors and funding

3 authors.

Tim KobesDepartment of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02115, USA. t.kobes-2@umcutrecht.nl.ORCID http://orcid.org/0000-0003-4618-3714
Mark C P M van BaalDepartment of Trauma Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht, GA, 3508, The Netherlands.
Marilyn HengDepartment of Orthopedic Surgery, University of Miami Miller School of Medicine, NW 14th Street, Miami, FL, 33136, USA.ORCID http://orcid.org/0000-0002-4047-6818

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWhat is the effect of surgical or conservative treatment on the in-hospital outcomes of patients with combined fractures of the clavicle and ribs?

designRetrospective cohort study.

settingTwo level-1 trauma centers and academic teaching hospitals in Boston, Massachusetts. PATIENTS: All adult patients with a clavicle fracture and ≥3 rib fractures admitted from 2016 to 2021.

interventionNone. MAIN OUTCOME MEASUREMENTS: Nosocomial pneumonia, hospital length-of-stay (HLOS), ICU length-of-stay (ILOS), days on mechanical ventilation (DMV).

results252 patients were included (212 conservative, 40 surgical; median age 62 years, 67% male). The median ISS and GCS scores were 17 and 15, respectively. Thirty-seven patients developed nosocomial pneumonia. For clavicle fixation (n = 26), the OR for pneumonia was 0.3 (95% CI 0.0-2.2), ILOS had a ß-coefficient of -2.6 (95% CI -5.9-0.8), and DMV a ß-coefficient of -3.6 (95% CI -12.0-4.8). For rib plating (n = 10), the OR for pneumonia was 1.4 (95% CI 0.2-8.6), HLOS had a ß-coefficient of 4.9 (95% CI -1.6-11.5), and ILOS a ß-coefficient of 4.1 (95% CI -0.4-8.6). For both surgeries (n = 4), the CIs were wide.

conclusionClavicle fixation in patients with combined injuries of the clavicle and ribs did not improve nor worsen in-hospital outcomes; the orthopedic surgeon should make a patient-tailored treatment decision. Rib plating did not improve in-hospital outcomes in non-flail patients with a concomitant clavicle fracture. Guidelines on non-flail rib plating could profit from these findings in combination with previous and additional research. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Indexed as

ClavicleHealthcare-Associated PneumoniaPropensity ScoreRib FracturesAdultAgedConservative TreatmentFemaleFractures, MultipleHumansLength of StayMaleMiddle AgedRespiration, ArtificialRetrospective StudiesClavicle fixationClavicle fractureIn-hospital outcomesInverse propensity score weightingRib fractureRib plating

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.